Judge clears Ocala trauma center

March 22--Ocala Regional Medical Center's new trauma center will continue operations for the foreseeable future following a Leon County circuit judge's ruling on Friday.

Munroe Regional Medical Center, Shands at the University of Florida and Shands Jacksonville Medical Center had petitioned Judge Terry Lewis in December, asking him to find that the Florida Department of Health acted outside its authority when granting Ocala Regional permission to start its trauma center.

The petition involved high clinical and financial stakes for players on both sides of the legal argument.

Until Ocala Regional's trauma center opened in December, the most severely injured Marion County patients were transported to Shands for trauma care. Much of that has now stopped and Shands predicts that one-third of its 2,500 annual trauma patients will be taken to Ocala Regional.

The new trauma center serves Marion, Lake, Sumter and Citrus counties.

In his one-page ruling Lewis did not explain his reasons for not granting Shands and Munroe their request. The lawsuit was filed against the Department of Health, not Ocala Regional.

Munroe released a statement soon after Lewis' ruling: "We are disappointed that the court did not overturn the Department of Health's approval of Ocala Regional Medical Center's (ORMC) trauma center, which we believe was done without statutory authority," Munroe CEO and President Steve Purves said.

"We believe a different legal result would have allowed Munroe, together with UF and Shands, to enhance the delivery of quality trauma services in central Florida and would have allowed a better alternative for our region rather than the development of another costly and duplicative trauma center.

"This order means that the Department of Health's approval of ORMC's trauma center is allowed to stand without consideration of the impact on the existing Level 1 trauma center located at Shands, and without consideration of need. Despite this result, Munroe Regional Medical Center looks forward to working with the Department of Health -- and other hospitals -- in developing a new system identifying the real need for trauma services throughout the state," Purves concluded.

Ocala Regional has a Level 2 trauma center, which means it does not provide the same scope of care for some cases and is not associated with an academic program.

Attorney Steve Ecenia represents Ocala Regional's parent company, Hospital Corporation of America (HCA), in the legal dispute. He said Shands and Munroe now must decide whether to appeal. They have 30 days.

"We'll just wait and see what happens, but we're pleased the judge didn't try and interfere with the Ocala area getting trauma care," he said.

Ecenia said he wasn't surprised that Lewis didn't spell out his reasons in a written order.

"I think he felt they didn't have a legal basis and it didn't warrant a legal opinion. We certainly didn't," Ecenia said. "They were grasping at legal straws and we're glad the judge thought they were too."

Seann Frazier, a Shands lawyer, said only that his client was disappointed in the judge's decision and that Shands hasn't yet decided about an appeal.

The dispute over Ocala Regional's trauma center stems from a long series of legal maneuvers involving the Department of Health, HCA and other hospitals with new trauma centers.

The legal story started in 2004 when the Florida Legislature told the Department of Health to update its rules concerning trauma centers. The rules had not changed since 1992.

But the department did not act. And in September 2011 an administrative law judge found that the department rules for determining the location and need for trauma centers were invalid.

In November the 1st District Court of Appeal upheld that administrative law judge's ruling. But the Department of Health granted Ocala Regional its provisional status before the appellate court's decision technically took effect -- thus allowing the new trauma center to slip in just under the legal wire.

Munroe Regional also applied for permission to open a trauma center but was denied.

Ocala Regional's trauma center is currently operating with a provisional license, and in about a year is slated to receive its permanent verification permit.

The Department of Health is currently establishing new rules in determining the need and placement of future trauma centers, and earlier this year took public input.

In a statement emailed to the Star-Banner, the Department of Health said: "The Court's (Judge Lewis') ruling helps to move Florida's trauma system forward. The order affirms the department's authority to designate trauma centers as part of its efforts to create an inclusive, sustainable trauma system dedicated to safe, effective and efficient care for every injured patient in Florida."

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